Mothers' Perspectives on a Peer-Delivered Behavioral Activation Program for Recovery Support: A Qualitative Study of...

Background: Fewer than one in four mothers with substance use disorders (SUD) receive adequate support. Existing interventions often overlook the intersection of recovery and caregiving. Peer-delivered models improve engagement but may lack structured behavioral strategies to address mental health needs within parenting contexts. Objective: To explore mothers' anticipated acceptability and perceived relevance of a peer-delivered program informed by Behavioral Activation (BA), an evidence-based approach that increases engagement in meaningful, values-consistent activities to improve mood and functioning. This study is explicitly formative and pre-implementation: participants reviewed selected BA-informed tools and provided structured feedback. Methods: Twenty-five mothers with lived experience of substance use during pregnancy or early parenting completed semi-structured interviews after reviewing BA-informed tools drawn from the Alma program. Interviews were transcribed and analyzed using a hybrid deductive-inductive thematic analysis. Results: Participants anticipated that the BA tools could support self-awareness, emotional regulation, and values-consistent action in recovery. Peer delivery by mentors with lived experience was viewed as central to trust and openness. Barriers included childcare demands, transportation, technology access, parenting stress, and fear of child welfare involvement. Facilitators included flexible formats, trauma-informed design, and alignment with diverse recovery pathways. Participants recommended trauma-informed pacing, simplified tracking, parenting-specific content, and harm reduction-inclusive framing. Conclusions: Peer-delivered BA-informed tools were perceived as acceptable and contextually relevant within a structured review context for mothers navigating recovery and early parenting. These formative findings provide participant-centered guidance for iterative adaptation prior to feasibility testing.